Postherpetic neuralgia (PHN) is a chronic nerve pain condition that can occur after a shingles outbreak (herpes zoster). Even after the rash heals, some patients are left with persistent, burning, stabbing, or aching pain in the area where the shingles occurred—most commonly on the chest, back, or face.
PHN results from nerve damage caused by the reactivation of the varicella-zoster virus and can last for months or even years, significantly affecting quality of life.
What Causes Postherpetic Neuralgia?
Shingles occurs when the varicella-zoster virus (the same virus that causes chickenpox) becomes reactivated, usually due to stress, aging, or a weakened immune system. In some patients, this reactivation damages the sensory nerves, leading to long-lasting neuropathic pain.
Risk factors for developing PHN include:
Age over 50
Severe or widespread shingles rash
Delay in antiviral treatment
Involvement of the trigeminal nerve (especially the eye or forehead)
Symptoms
Burning, stabbing, or aching pain in the area of the previous shingles rash
Extreme sensitivity to touch (allodynia)—even light clothing may cause pain
Numbness or tingling
Itching or hypersensitivity in the affected area
Pain that lasts more than 3 months after the rash has healed
Conservative Treatment Options
Medications
Neuropathic agents:
Gabapentin or pregabalin to reduce nerve irritation
Tricyclic antidepressants (e.g., amitriptyline) to modulate pain signals
Topical treatments:
Lidocaine patches or capsaicin cream applied directly to painful skin
Oral pain relievers:
NSAIDs or tramadol (short-term use)
Lifestyle and Supportive Care
Loose clothing and gentle skin care
Cognitive-behavioral therapy (CBT) or relaxation techniques to help manage chronic pain
Vaccination with Shingrix to prevent shingles and reduce PHN risk in older adults
Interventional Pain Management Options
For patients who do not respond to medications or experience intolerable side effects, interventional procedures can offer meaningful relief:
Peripheral Nerve Blocks
Targeted nerve block injections at the site of the affected sensory nerves
Useful for PHN in the thoracic region, face (trigeminal), or cervical spine
May provide both diagnostic and therapeutic benefits
Stellate Ganglion Block
Especially helpful for facial or upper body PHN, such as after shingles affecting the eye or forehead
Can reduce pain by calming sympathetic nervous system overactivity
Epidural Steroid Injections
For thoracic or lumbar PHN, epidural injections may help reduce inflammation and modulate nerve signaling
Radiofrequency Ablation (RFA)
In selected cases, RFA can reduce pain by disrupting overactive pain signals in damaged nerve fibers
Spinal Cord Stimulation (SCS)
For refractory, widespread, or severe cases, an implanted device delivers electrical pulses to override pain signals
Particularly effective in patients with failed medication trials
When to Seek Help
If you’re still experiencing nerve pain 3 months or more after a shingles outbreak, you may have postherpetic neuralgia. Early intervention improves outcomes, especially when pain begins to interfere with sleep, mood, or daily activities.
Relief Is Within Reach
At Parkview Spine & Pain, we specialize in advanced therapies for neuropathic pain conditions like postherpetic neuralgia. With a personalized treatment approach—including medication management and image-guided nerve blocks—we help you reclaim your quality of life.
👉 Contact us today to schedule your consultation and begin your path to lasting relief.